Cervical cancer screening in Latvia: a brief history and recent improvements (2009-2011).

Screening for cervical cancer (CC) has been an important part of prevention strategies in Latvia since the early 1960s, reducing its incidence from 31.7/100,000 women in 1963 to 8.9/100,000 in 1989. Political and socioeconomic changes after 1991 greatly affected the entire healthcare system, including CC screening, which was temporarily suspended. In 2005, CC screening targeting all women 25 to 69 years old was officially reintroduced in Latvia, with revision in 2007. However, the nature of the screening program remained opportunistic. The inactivity of women, lack of availability of the required services, overloaded general practitioners, and lack of involvement of gynecologists and obstetricians resulted in low coverage of the target population (10% in 2005-2006). Organized screening was finally implemented in Latvia in 2009. Currently, the national Health Payment Center is responsible for inviting women for screening. Cytological smears, principally performed in a 3-year interval, are read by cytopathologists and cytotechnologists at 25 government-based and private laboratories. Cytological testing outside the program is still very frequent and performed on an ongoing basis in parallel with the organized screening. The results of the first round of screening (2009-2011) show encouraging trends, with a stepwise increase in positive responses to the invitation letter, an increase in coverage inside the program, and increasing detection of cervical high-grade lesions and carcinoma in situ. Unfortunately there is still no cytology quality control monitoring in place, and there are no clear recommendations for human papillomavirus (HPV) testing. Because HPV testing is not reimbursed, it is rarely performed.